AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).
BACKGROUND Colorectal cancer(CRC)is the third most common cause of cancer-related death worldwide.Despite significant advances in screening,surgical management and adjuvant therapies,average 5-year survival seldom exc...BACKGROUND Colorectal cancer(CRC)is the third most common cause of cancer-related death worldwide.Despite significant advances in screening,surgical management and adjuvant therapies,average 5-year survival seldom exceeds 60%in most developed nations.Metastatic disease represents the primary cause of mortality in patients with CRC,and the liver is the most common location for distant tumour spread.Up to 25%of patients are found to have synchronous liver metastases at the time of diagnosis and a further 30%-40%will develop metachronous disease in the course of follow-up.It has been suggested that primary tumour location[right side versus left side,primary tumour location(PTL)]can influence oncological outcomes in this patient group and that this should be considered in prognostic models and therapeutic decision-making algorithms.This suggestion is not universally accepted and there have been conflicting reports in the literature to date.AIM To provide a comprehensive summary of the available evidence regarding the impact of PTL on oncological outcomes in patients with colorectal cancer liver metastases(CRCLM).METHODS MEDLINE,EMBASE and COCHRANE were searched for relevant publications using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology.Data on oncological outcomes was then extracted from full text articles that met the predefined inclusion criteria.RESULTS A total of 41 studies were identified that met predefined inclusion criteria for this review.In 21 out of 38 studies that provided data on overall survival,a statistically significant improvement in overall survival was reported in patients with left sided primary tumours.These studies included a total of 13897 patients compared with 4306 patients in the studies that did not show a significant difference.Eight studies noted a similar trend towards improved disease-free or progression-free survival.Several authors observed distinct patterns of relapse after treatment of hepatic metastases according to PTL;for example hepatic recurrence after treatment of CRCLM appears to occur more aggressively with right-sided CRC.CONCLUSION Taken together,the findings of the present review indicate that PTL may have a role as an independent prognostic factor when determining treatment and disease surveillance strategies in CRC.The mechanisms responsible for this variation remain poorly understood,but are likely to relate to molecular,histological and embryological differences,as well as inherent differences in therapeutic sensitivity.展开更多
Colorectal cancer(CRC) treatment has become more personalised,incorporating a combination of the individual patient risk assessment,gene testing,and chemotherapy with surgery for optimal care.The improvement of stagin...Colorectal cancer(CRC) treatment has become more personalised,incorporating a combination of the individual patient risk assessment,gene testing,and chemotherapy with surgery for optimal care.The improvement of staging with high-resolution imaging has allowed more selective treatments,optimising survival outcomes.The next step is to identify biomarkers that can inform clinicians of expected prognosis and offer the most beneficial treatment,while reducing unnecessary morbidity for the patient.The search for biomarkers in CRC has been of significant interest,with questions remaining on their impact and applicability.The study of biomarkers can be broadly divided into metabolic,molecular,micro RNA,epithelial-to-mesenchymal-transition(EMT),and imaging classes.Although numerous molecules have claimed to impact prognosis and treatment,their clinical application has been limited.Furthermore,routine testing of prognostic markers with no demonstrable influence on response to treatment is a questionable practice,as it increases cost and can adversely affect expectations of treatment.In this review we focus on recent developments and emerging biomarkers with potential utility for clinical translation in CRC.We examine and critically appraise novel imaging and molecular-based approaches; evaluate the promising array of micro RNAs,analyze metabolic profiles,and highlight key findings for biomarker potential in the EMT pathway.展开更多
BACKGROUND Personalized nutrition and protective diets and lifestyles represent a key cancer research priority.The association between consumption of specific dietary components and colorectal cancer(CRC)incidence has...BACKGROUND Personalized nutrition and protective diets and lifestyles represent a key cancer research priority.The association between consumption of specific dietary components and colorectal cancer(CRC)incidence has been evaluated by a number of population-based studies,which have identified certain food items as having protective potential,though the findings have been inconsistent.Herein we present a systematic review and meta-analysis on the potential protective role of five common phytochemically rich dietary components(nuts,cruciferous vegetables,citrus fruits,garlic and tomatoes)in reducing CRC risk.AIM To investigate the independent impact of increased intake of specific dietary constituents on CRC risk in the general population.METHODS Medline and Embase were systematically searched,from time of database inception to January 31,2020,for observational studies reporting CRC incidence relative to intake of one or more of nuts,cruciferous vegetables,citrus fruits,garlic and/or tomatoes in the general population.Data were extracted by two independent reviewers and analyzed in accordance with the Meta-analysis of Observational Studies in Epidemiology(MOOSE)and Preferred Reporting Items for Systematic Review and Meta-analysis(PRISMA)reporting guidelines and according to predefined inclusion/exclusion criteria.Effect sizes of studies were pooled using a random-effects model.RESULTS Forty-six studies were identified.CRC risk was significantly reduced in patients with higher vs lower consumption of cruciferous vegetables[odds ratio(OR)=0.90;95%confidence interval(CI):0.85-0.95;P<0.005],citrus fruits(OR=0.90;95%CI:0.84-0.96;P<0.005),garlic(OR=0.83;95%CI:0.76-0.91;P<0.005)and tomatoes(OR=0.89;95%CI:0.84-0.95;P<0.005).Subgroup analysis showed that this association sustained when looking at case-control studies alone,for all of these four food items,but no significant difference was found in analysis of cohort studies alone.Nut consumption exhibited a similar trend,but overall results were not significant(OR=0.72;95%CI:0.50-1.03;P<0.07;I2=90.70%).Putative anticarcinogenic mechanisms are proposed using gene-set enrichment analysis of gene/protein perturbations caused by active compounds within each food item.CONCLUSION Increased cruciferous vegetable,garlic,citrus fruit and tomato consumption are all inversely associated with CRC risk.These findings highlight the potential for developing precision nutrition strategies for CRC prevention.展开更多
基金Supported by Cancer Research United KingdomWessex Medical Research
文摘AIM: To systematically review the available evidence regarding cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) for colorectal peritoneal metastases (CPM).
文摘BACKGROUND Colorectal cancer(CRC)is the third most common cause of cancer-related death worldwide.Despite significant advances in screening,surgical management and adjuvant therapies,average 5-year survival seldom exceeds 60%in most developed nations.Metastatic disease represents the primary cause of mortality in patients with CRC,and the liver is the most common location for distant tumour spread.Up to 25%of patients are found to have synchronous liver metastases at the time of diagnosis and a further 30%-40%will develop metachronous disease in the course of follow-up.It has been suggested that primary tumour location[right side versus left side,primary tumour location(PTL)]can influence oncological outcomes in this patient group and that this should be considered in prognostic models and therapeutic decision-making algorithms.This suggestion is not universally accepted and there have been conflicting reports in the literature to date.AIM To provide a comprehensive summary of the available evidence regarding the impact of PTL on oncological outcomes in patients with colorectal cancer liver metastases(CRCLM).METHODS MEDLINE,EMBASE and COCHRANE were searched for relevant publications using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology.Data on oncological outcomes was then extracted from full text articles that met the predefined inclusion criteria.RESULTS A total of 41 studies were identified that met predefined inclusion criteria for this review.In 21 out of 38 studies that provided data on overall survival,a statistically significant improvement in overall survival was reported in patients with left sided primary tumours.These studies included a total of 13897 patients compared with 4306 patients in the studies that did not show a significant difference.Eight studies noted a similar trend towards improved disease-free or progression-free survival.Several authors observed distinct patterns of relapse after treatment of hepatic metastases according to PTL;for example hepatic recurrence after treatment of CRCLM appears to occur more aggressively with right-sided CRC.CONCLUSION Taken together,the findings of the present review indicate that PTL may have a role as an independent prognostic factor when determining treatment and disease surveillance strategies in CRC.The mechanisms responsible for this variation remain poorly understood,but are likely to relate to molecular,histological and embryological differences,as well as inherent differences in therapeutic sensitivity.
文摘Colorectal cancer(CRC) treatment has become more personalised,incorporating a combination of the individual patient risk assessment,gene testing,and chemotherapy with surgery for optimal care.The improvement of staging with high-resolution imaging has allowed more selective treatments,optimising survival outcomes.The next step is to identify biomarkers that can inform clinicians of expected prognosis and offer the most beneficial treatment,while reducing unnecessary morbidity for the patient.The search for biomarkers in CRC has been of significant interest,with questions remaining on their impact and applicability.The study of biomarkers can be broadly divided into metabolic,molecular,micro RNA,epithelial-to-mesenchymal-transition(EMT),and imaging classes.Although numerous molecules have claimed to impact prognosis and treatment,their clinical application has been limited.Furthermore,routine testing of prognostic markers with no demonstrable influence on response to treatment is a questionable practice,as it increases cost and can adversely affect expectations of treatment.In this review we focus on recent developments and emerging biomarkers with potential utility for clinical translation in CRC.We examine and critically appraise novel imaging and molecular-based approaches; evaluate the promising array of micro RNAs,analyze metabolic profiles,and highlight key findings for biomarker potential in the EMT pathway.
文摘BACKGROUND Personalized nutrition and protective diets and lifestyles represent a key cancer research priority.The association between consumption of specific dietary components and colorectal cancer(CRC)incidence has been evaluated by a number of population-based studies,which have identified certain food items as having protective potential,though the findings have been inconsistent.Herein we present a systematic review and meta-analysis on the potential protective role of five common phytochemically rich dietary components(nuts,cruciferous vegetables,citrus fruits,garlic and tomatoes)in reducing CRC risk.AIM To investigate the independent impact of increased intake of specific dietary constituents on CRC risk in the general population.METHODS Medline and Embase were systematically searched,from time of database inception to January 31,2020,for observational studies reporting CRC incidence relative to intake of one or more of nuts,cruciferous vegetables,citrus fruits,garlic and/or tomatoes in the general population.Data were extracted by two independent reviewers and analyzed in accordance with the Meta-analysis of Observational Studies in Epidemiology(MOOSE)and Preferred Reporting Items for Systematic Review and Meta-analysis(PRISMA)reporting guidelines and according to predefined inclusion/exclusion criteria.Effect sizes of studies were pooled using a random-effects model.RESULTS Forty-six studies were identified.CRC risk was significantly reduced in patients with higher vs lower consumption of cruciferous vegetables[odds ratio(OR)=0.90;95%confidence interval(CI):0.85-0.95;P<0.005],citrus fruits(OR=0.90;95%CI:0.84-0.96;P<0.005),garlic(OR=0.83;95%CI:0.76-0.91;P<0.005)and tomatoes(OR=0.89;95%CI:0.84-0.95;P<0.005).Subgroup analysis showed that this association sustained when looking at case-control studies alone,for all of these four food items,but no significant difference was found in analysis of cohort studies alone.Nut consumption exhibited a similar trend,but overall results were not significant(OR=0.72;95%CI:0.50-1.03;P<0.07;I2=90.70%).Putative anticarcinogenic mechanisms are proposed using gene-set enrichment analysis of gene/protein perturbations caused by active compounds within each food item.CONCLUSION Increased cruciferous vegetable,garlic,citrus fruit and tomato consumption are all inversely associated with CRC risk.These findings highlight the potential for developing precision nutrition strategies for CRC prevention.
